PEPFAR 3.0 takes on sustainable control, activism confronts TB drug barrier. . . We’re reading about responsibility and results

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NewWWRPEPFAR 3.0 Controlling the Epidemic Delivering on the Promise . . . When the U.S. President’s Emergency Plan for AIDS Relief was launched in 2004, nearly a decade after antiretroviral treatment began saving the lives of people living with HIV in the United States, the word “emergency” in its title was an understatement, this document, released on World AIDS Day by the U.S. Office of the Global AIDS Coordinator, notes. Through challenges and successes the program’s role has shifted, and this document presents components of an approach to control the epidemic sustainably. Presenting steps for five “agendas” (of impact, efficiency, sustainability, partnership, and human rights) that Global AIDS Coordinator Ambassador Deborah Birx has emphasized, it lays out a four-year plan that includes the year just passed. It is both modest and ambitious. The introduction pledges “As we have done since the creation of the program, we will work to leave no population of greatest risk behind,” which can be looked at as a modest pledge, since the focus is, in reality a recent one. Highlighting the newness of the effort, the section on the “human rights agenda” then, ambitiously pledges to “implement civil society and human rights frameworks in all PEPFAR countries,” and to “implement Gender and Sexual Diversity Training in all PEPFAR countries,” this year. The “impact“ agenda stresses steps to “validate,” assess,” “demonstrate” and analyze the success of efforts, which also might sound like modest goals — except that they too are relatively new ones. While it sets 2016 as the year to “demonstrate clear progress towards an AIDS-free generation in four years,” it doesn’t spell out the numbers of people on treatment necessary to achieve that. At the same time, the goal, by 2018, to “demonstrate epidemiological control” in at least half of high burden countries, suggests the goals set by UNAIDS of at least 90 percent of those living with HIV knowing their status, at least 90 percent of those knowing their status, and at least 90 percent of those people maintaining treatment successful enough to control their viruses. In a funding environment that remains uncertain, that will mean accountability for the impact of every dollar.

Activism on rifapentine pricing: removing cost barriers to improve the uptake of tuberculosis research innovations . . . In 2012 the potential for rifapentine, a tuberculosis drug developed by the Sanofi pharmaceutical company with U.S. support, to shorten courses of TB treatment to 12 weeks was promising. But, with a price of $75 a box, TB community advocates found, it was a promise unlikely to be realized. This article documents advocates’ efforts to back their concerns, build support for their position and communicate with the drug company over the year and a half that followed until the Sanofi dropped the price of the drug to $35 a box, lower than the price advocates had suggested. While the article notes that the relation between effort and result is hard to prove outside of randomized trials, the persistence and collaboration of the effort encourages continued work make the drug widely accessible.


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